Provider Demographics
NPI:1730407180
Name:GUPITEO, AMY (F N P)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GUPITEO
Suffix:
Gender:F
Credentials:F N P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:97 NEW DORP LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2364
Mailing Address - Country:US
Mailing Address - Phone:718-876-6220
Mailing Address - Fax:718-876-5969
Practice Address - Street 1:191 BRADLEY AVE
Practice Address - Street 2:GOLDEN GATE NURSING HOME
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5166
Practice Address - Country:US
Practice Address - Phone:718-351-1136
Practice Address - Fax:718-876-5969
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2013-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF336175-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03282602Medicaid
NYA400040254Medicare Oscar/Certification
NY03282602Medicaid